Journal of the Formosan Medical Association
Volume 107, Issue 10 , Pages 767-773, October 2008

Masson Trichrome Stain Helps Differentiate Myofibroma from Smooth Muscle Lesions in the Head and Neck Region

  • Julia Yu Fong Chang

      Affiliations

    • Department of Diagnostic Sciences, Oral Pathology, Baylor College of Dentistry, Texas A&M University System Health Science Center, Dallas, Texas, USA
    • School of Dentistry and Dental Department of National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Julia Yu Fong Chang, School of Dentistry, College of Medicine, National Taiwan University, 1 Chang-Te Street, Taipei 100, Taiwan
    • ,
  • Harvey P. Kessler

      Affiliations

    • Department of Diagnostic Sciences, Oral Pathology, Baylor College of Dentistry, Texas A&M University System Health Science Center, Dallas, Texas, USA

Received 3 April 2008; received in revised form 30 April 2008; accepted 6 May 2008.

Article Outline

Background/Purpose

Myofibromas are well described in the head and neck region, but differentiating them from smooth muscle lesions is still difficult using smooth muscle immunohistochemical stains. This study evaluated the usefulness of the Masson trichrome stain in differentiating myofibromas from smooth muscle lesions in the head and neck region.

Methods

Samples of 11 oral myofibromas, two leiomyomas, one angioleiomyoma, and one smooth muscle hamartoma were retrieved from our archives. Immunohistochemistry and Masson trichrome stains were performed on tissue sections of these lesions.

Results

All 11 oral myofibromas, seven from male patients and four from female patients, were solitary myofibromas. The patients' mean age at diagnosis was 32.8 years. Oral myofibromas occurred most commonly on the gingiva (four cases) and in the mandible (three cases). With the Masson trichrome stain, the smooth muscle cell cytoplasm was stained red, while the collagenous fibrous tissue was stained blue. Myofibromas and smooth muscle lesions demonstrated different characteristic patterns with the Masson trichrome stain. Myofibromas were composed of a much more collagenous stroma intermixed with the spindle cells. Thick fibrous bundles with random, irregularly intersecting angles were prominent in myofibromas. Smooth muscle lesions showed only minimal delicate fibrous tissue surrounding the smooth muscle cells and in the septa between the smooth muscle masses. On low-power view, red masses of smooth muscle tumor surrounded by blue fibrous tissue were observed.

Conclusion

The Masson trichrome stain can be a useful tool to differentiate myofibromas from smooth muscle lesions, but immunohistochemical methods to rule out other spindle cell lesions are still needed.

Key Words:  leiomyoma , Masson trichrome stain , myofibroma , smooth muscle tumor

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Chung EB , Enzinger FM . Infantile myofibromatosis . Cancer . 1981;48:1807–1818
  2. Daimaru Y , Hashimoto H , Enjoji M . Myofibromatosis in adults (adult counterpart of infantile myofibromatosis) . Am J Surg Pathol . 1989;13:859–865
  3. Speight PM , Dayan D , Fletcher CD . Adult and infantile myofibromatosis: a report of three cases affecting the oral cavity . J Oral Pathol Med . 1991;20:380–384
  4. Foss RD , Ellis GL . Myofibromas and myofibromatosis of the oral region: a clinicopathologic analysis of 79 cases . Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2000;89:57–65
  5. Montgomery E , Speight PM , Fisher C . Myofibromas presenting in the oral cavity: a series of 9 cases . Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2000;89:343–348
  6. Pathology and genetics of tumors of soft tissue and bone . In:  Fletcher CDM ,  Unni KK ,  Mertens F editor. World Health Organization Classification of Tumors . Lyon, France: International Agency for Research on Cancer (IARC); 2002;p. 59–61
  7. Tumors of the soft tissues . In:  Kempson RL ,  Fletcher CDM ,  Evans HL , et al. editor. Atlas of Tumor Pathology . Washington DC, USA: Armed Forces Institute of Pathology; 2001;p. 64–67
  8. Benjamin SP , Mercer RD , Hawk WA . Myofibroblastic contraction in spontaneous regression of multiple congenital mesenchymal hamartomas . Cancer . 1977;40:2343–2352
  9. Fletcher CD , Achu P , Van Noorden S , et al.   Infantile myofibromatosis: a light microscopic, histochemical and immunohistochemical study suggesting true smooth muscle differentiation . Histopathology . 1987;11:245–258
  10. Stout AP . Juvenile fibromatoses . Cancer . 1954;7:953–978
  11. Rosenberg HS , Stenback WA , Spjut HJ . The fibromatoses of infancy and childhood . Perspect Pediatr Pathol . 1978;4:269–348
  12. Liew SH , Haynes M . Localized form of congenital generalized fibromatosis. A report of 3 cases with myofibroblasts . Pathology . 1981;13:257–266
  13. Eyden B . The myofibroblast. An assessment of controversial issues and a definition useful in diagnosis and research . Ultrastruct Pathol . 2001;25:39–50
  14. Ceballos KM , Nielsen GP , Selig MK , et al.   Is antih-caldesmon useful for distinguishing smooth muscle and myofibroblastic tumors? An immunohistochemical study . Am J Clin Pathol . 2000;114:746–753
  15. Fisher C . Myofibrosarcoma . Virchows Arch . 2004;445:215–223
  16. Eyden B . The fibronexus in reactive and tumoral myofibroblasts: further characterisation by electron microscopy . Histol Histopathol . 2001;16:57–70

PII: S0929-6646(08)60189-8

doi:10.1016/S0929-6646(08)60189-8

Journal of the Formosan Medical Association
Volume 107, Issue 10 , Pages 767-773, October 2008

Article Tools